Abstract
We present a case of fine ventricular fibrillation (VF) misdiagnosed as right ventricular (RV) lead noise in a patient with left ventricular assist device (LVAD). To demonstrate that fine VF may be misdiagnosed as lead noise. N/A A 66 year old man with non-ischemic cardiomyopathy with Heartmate II LVAD and an Abbott/St Jude biventricular implantable cardioverter-defibrillator (ICD), permanent atrial fibrillation and prior ventricular tachycardia (VT) storm presented with complaints of multiple shocks and was found to be in fine VF. LVAD flow was at 3.2 L/min and pulsatility index (PI) was low at 1.4 indicating lack of myocardial contractility. Amiodarone was initiated and he was transferred to our center. Upon arrival, he remained in VF (Figure 1). Device interrogation revealed VT with appropriate shocks initiating the VF, and that fine VF was labelled as RV lead noise (Figure 1) and therapy withheld. He previously had Secure Sense turned off because of under sensing of VT; due to low amplitude of near field electrogram (EGM), (0.1mV), the device sensed it as RV lead noise. With LVAD support, he remained awake for 7 hours. Due to intolerance of amiodarone or sotalol therapy in the past, lidocaine was added without effect; he was then switched to procainamide drip and was externally cardioverted successfully with 300J. Instantaneously, his mean arterial pressures improved and his LVAD monitor showed a flow of 4.4 L/min and a PI of 2.4. The patient’s device appropriately recognized and shocked his initial VT. However, it has failed to recognize fine VF regardless of appropriate lead function due to low amplitude EGM. LVAD kept him alive for 7 hours.
Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
